The association between psychosocial working conditions and the quality of delivered patient care: a prospective study among medical assistants

背景：卫生保健部门的工作条件一直被认为是情感上的苛求。这种恶劣的心理社会工作条件不仅是影响保健工作人员健康和工作能力的一个风险因素，而且还与提供较差的病人护理（例如，错误率增加）有关。这种关系在护士和医生中已经被反复证实。然而，迄今为止，医疗助理（MAs）受到的关注很少，尽管他们i)代表了门诊护理中最大的专业人群，ii)经历了情感上繁重的工作条件，以及iii)执行了大量与患者护理相关的任务。目的：总体目标是检查心理社会工作条件和ma患者护理质量之间的潜在关联。设想的项目将特别作出新的贡献：i)考虑病人护理的各种质量指标，ii)前瞻性数据的利用，iii)基于理论的解释机制的检查。方法：2016年末，申请人共调查了944名MAs（“基线”）。将在2019年底对这一人群进行随访。心理社会工作条件（即暴露）将通过既定的工具（即努力-奖励不平衡问卷）和专门为MAs设计的问卷来测量，其中包括工作需求，合作，实践组织和MAs主管的特征。护理质量将通过以下问题进行评估：已发生的重大医疗错误、文件错误以及与患者的社会互动质量（即结果）。根据理论模型确定的潜在中介因素包括工作满意度低和心理健康受损等。前瞻性关系将通过多变量二项回归模型（二分类结果）和线性回归（即连续结果的变化分数）进行检验。潜在的调解将通过“差异法”进行评估。启示：基于前瞻性数据和理论模型，预期的研究将提供潜在关联和解释机制的证据。这些见解可以为工作场所干预措施的发展提供信息，以改善MAs的工作条件，从而提高他们提供的护理质量。

Background: Working conditions in the health care sector have been characterized as emotionally demanding. Such poor psychosocial working conditions represent not only a risk factor for the health and workability of health care staff, but are also associated with the delivery of poorer patient care (e.g., increased rates of errors). This relationship has repeatedly been documented among nurses and physicians. Medical assistants (MAs) have however received very little attention to date despite the fact that they i) represent the largest professional population in outpatient care, ii) experience emotionally taxing working conditions, and iii) perform a large range of tasks that are relevant to patient care.Objective: The overarching objective is to examine the potential associations between psychosocial working conditions and the quality of delivered patient care among MAs. The envisioned project will specifically make novel contributions by i) considering various types of quality indicators of patient care, ii) the utilization of prospective data and iii) theory-based examination of explanatory mechanisms.Methods: In late 2016, a total of 944 MAs were surveyed („baseline“) by the applicant. This population will be followed-up in late 2019. Psychosocial working conditions (i.e., the exposures) will be measured by an established instrument (i.e. the effort-reward imbalance questionnaire) and a questionnaire specifically designed for MAs, which measures, amongst others, job demands, cooperation, practice organization and characteristics of MAs’ supervisors. Quality of care will be assessed by questions on major medical errors that have been made, on documentation errors and on the quality of the social interaction with patients (i.e., the outcomes). Potential mediators, which were identified based on a theoretical model, include for instance a poor job satisfaction and impaired mental health. Prospective relationships will be examined by multivariable binomial regressions models (for dichotomous outcomes) and linear regression (i.e. change score for continuous outcomes). Potential mediation will be assessed by the “difference method“.Implications: Based on prospective data and a theoretical model the envisioned study will provide evidence on potential associations and explanatory mechanisms. These insights may inform the development of workplace interventions to improve MAs’ working conditions and thereby the quality of care they provide.